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PCRC VBS Registration Form 2024
Please complete a form for each child.
For children entering SK to Grade 6.
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* Indicates required question
Email
*
Your email
Child's name (first and last):
*
Your answer
Birthday:
*
MM
/
DD
/
YYYY
What grade are they going into in the fall?
*
Your answer
Parent #1 name:
*
Your answer
Parent #1 phone number:
*
Your answer
Parent #2 name:
*
Your answer
Parent #2 phone number:
*
Your answer
Home Address:
*
Your answer
Medical Permission: In the event of a medical emergency, I authorize the Palmerston CRC staff to take appropriate measures (administer first aid, call EMS etc.)
*
Yes
No
Allergies or Important medical information
*
Your answer
Family Doctor:
*
Your answer
Family Doctors phone #:
*
Your answer
Emergency Contact #1 (other than a parent) Name and Number:
*
Your answer
Relationship to child:
*
Your answer
Emergency contact #2 (other than a parent) name and number:
*
Your answer
Relationship to child:
*
Your answer
Will anyone other than a parent pick up your child from VBS?
*
Yes
No
If yes, please list all those who would:
*
Your answer
I grant permission for my child/children listed on this form, to be included in pictures, promotional material, and publications connected with Vacation Bible School and issued by Palmerston Christian Reformed Church.
*
Yes
No
Your Name:
*
Your answer
Are you willing/able to volunteer at VBS?
*
Yes, please contact me
No
Send me a copy of my responses.
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